ST. CLOUD — In November, doctors and nurses in military fatigues arrived at St. Cloud Hospital to aid a depleted staff that was exhausted physically and emotionally.

COVID-19 patients were spilling out of the hospital's intensive care unit, and the positivity rate was 18% — astonishingly high at the time. The 23-member strike team sent by the Defense Department, one of two dispatched to Minnesota, was considered a godsend, "desperately needed and a lift in our spirits," said Ken Holmen, chief executive at CentraCare, which runs St. Cloud Hospital.

Fast forward two months and the situation is even more grim for CentraCare, the region's largest health care system. In early January, one in three people tested by CentraCare was positive for COVID-19. More than a quarter of the hospital is filled by COVID patients. And the federal strike team is scheduled to leave next week.

Stearns County last week had the second-highest case increase per capita in the state — shooting from 557 cases per 100,000 people during the first week of January to 1,662 per 100,000 last week.

Meanwhile, CentraCare's increasingly desperate pleas for mask mandates have fallen on deaf ears.

"We are all frustrated, beyond frustrated," said Dr. Kim Tjaden, a family physician with CentraCare who asked St. Cloud-area leaders to implement a temporary mask mandate during a virtual meeting Jan. 7. Among those present: mayors of St. Cloud and Waite Park, as well as county leaders and city council members.

But no mayors would pass a citywide mask mandate, even temporarily. They cited troubles with enforcement or an anticipated lack of support from council members, even as most other major metropolitan areas in Minnesota implemented some form of mandate. Those cities included Minneapolis, St. Paul, Duluth and Rochester.

"The recent statement to our civic officials is a recognition that we can't do it alone," said Dr. George Morris, CentraCare's COVID-19 incident commander.

Despite a refusal to pass mandates, the mayors of St. Cloud and the neighboring cities of Sartell, Sauk Rapids and Waite Park jointly signed a letter encouraging residents to wear masks when indoors. Waite Park also implemented a mask mandate for city buildings.

"Even that was a little bit of a hard sell to everybody," Waite Park Mayor Rick Miller said. "We didn't even take it to a vote. We just discussed it [and] decided to do it."

With no citywide mask mandates in effect, CentraCare leaders took their plea last week directly to businesses and residents.

"We found 800 people positive on [Jan. 14]. That's just insane numbers of people — and we're not even testing everybody," Morris said.

"It becomes a math game where if you get that many exposures or people testing positive, you're going to get that many people who put vulnerable individuals at risk. There's another subset that ends up hospitalized and another subset that ends up dead."

The omicron tsunami, as Morris calls it, is sickening health care workers at unprecedented rates, too.

"If our workforce is sick, we can't do any care let alone quality emergency or COVID-related care," Morris added. "It comes down to: The capacity of the health system has been exceeded for 22 months now. There's nothing left in the tank."

No other options

Besides caring for sick individuals, CentraCare has for months worked to reach underserved communities with education, health care resources and COVID-19 vaccine access. Leaders have met with local officials and shared up-to-date data on social media. With cases still rising — and testing supplies running scarce — CentraCare has tightened visitor restrictions and mandated medical-grade masks at its facilities.

"We have done everything we can from a medical health care system perspective to meet the needs of our communities," Morris said. "We have no other places to go, no other options. We need policy to support behaviors."

St. Cloud Mayor Dave Kleis said he does not believe it is his role, or the city's, to implement mask mandates or other pandemic regulations.

"We talked, and I said it would be a much better approach if we were all united — the business community, the cities, the counties, the nonprofits — and have a very strong ask and urging for folks to do that," he said.

"I believe there is better compliance when you can come together as a community and ask people to to help with the health directives for a period of time."

Local health care leaders disagree.

"It's less about the enforcement of the rule. It's more about setting the level of expectations that we are all in this together," Morris said. "And then we hold each other accountable to those community behaviors because they are in the public interest."

St. Cloud resident Amber Young said Monday that she isn't vaccinated and doesn't wear masks. She said she thinks face coverings are useless and mandates requiring them are futile.

The pandemic is "dumb," she said. "People need to get used to it. It's not going anywhere. When are we going to stop wearing masks? That's the question. Never?"

For 76-year-old Sharon Holm of South Haven, masks feel claustrophobic. She doesn't like them. But she also doesn't mind digging out her mask if requested or mandated.

"I'll wear it. I keep it in my pocket," Holm said.

'Hope isn't a strategy'

Morris said CentraCare leaders have requested the federal strike team stick around for another 30 days; they'll learn this week if that request is granted.

"We recognize we're not the only place in the country that's struggling," he said.

Despite the lack of sweeping mask mandates, area leaders have taken small steps to help curb the spread of COVID-19.

This week, Sartell Mayor Ryan Fitzthum sent a letter to residents asking them to mask up and take basic precautions, recognizing the community has a "short window to create an impact."

Also this week, Bishop Donald Kettler of the Diocese of St. Cloud implemented a mask mandate for all indoor parish activities, including mass and in-person learning at parochial schools, regardless of vaccination status.

And Monday, St. Cloud City Council Member Carol Lewis plans to bring up masks at the council meeting, potentially setting the stage for some form of mandate.

"We're hoping we can see a behavior change, but that hope isn't a strategy," Morris said. "We expect to peak in one or two weeks, but even when we're past peak, we'll still be blistering hot for another two to three weeks. We're a long ways away from an endemic."